Healthcare Provider Details

I. General information

NPI: 1649917691
Provider Name (Legal Business Name): ALLY ADULT FOSTER CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2022
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 UNION ST STE 35
WEST SPRINGFIELD MA
01089-3485
US

IV. Provider business mailing address

425 UNION ST STE 35
WEST SPRINGFIELD MA
01089-3485
US

V. Phone/Fax

Practice location:
  • Phone: 413-301-7774
  • Fax: 413-363-1724
Mailing address:
  • Phone: 413-301-7774
  • Fax: 413-363-1724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: BETH K - GRIFFIN
Title or Position: MANAGER
Credential:
Phone: 413-301-7774